Causes of hydrocele around the testicle and its treatment in Türkiye

Picture of a testicular hydrocele

The hydrocele around the testicle is a collection of fluid inside the scrotum, which looks like swelling in the testicle. Learn about the cause of a hydrocele and how removing water from the testicle is performed.

A hydrocele is a type of swelling in the scrotum due to fluid gathering around the testicle in the sheath surrounding the testicle and not inside the testicle, as we will see – that is, the size of the testicle remains normal. The infection is common in newborns and often disappears without treatment by the age of one year.

In fact, hydroceles disease is called in English by the name of hydrocele Which is often not dangerous, but it is preferable to see a doctor to follow up on the condition.

Image showing the difference between a normal scrotum and a swollen scrotum due to a hydrocele around the testis
We note the shape of the hydrocele around the testis, which causes swelling of the scrotum, compared with the normal shape of the scrotum

Types of hydrocele

There are two types of hydrocele around the testicle:

Connected hydrocele

In the third trimester of pregnancy, the testicles descend from the abdominal cavity into the scrotum. During their descent, the sheath process surrounds them and descends with them. This process then closes after descent (non-descending of the testicles results in Migratory testicles).

This type of hydrocele occurs because the sheath process surrounding the testicle remains open, leading to a connection between the scrotum and the abdominal cavity, which leads to fluid leakage into the scrotum, and a connected hydrocele is formed in it. This condition is present at birth.

Non-connected hydrocele

Some fluid accumulates in the scrotum, but there is no connection between it and the abdominal cavity. This condition may be present at birth and may appear in adults for various reasons.

Picture of types of hydrocele
An image showing the types of hydrocele, where we notice the connection of the hydrocele with the abdomen in the continuous type and its separation in the separated type

Causes of a hydrocele around the testicle

A hydrocele is a swelling inside the scrotum due to fluid gathering. This gathering occurs as a result of the following reasons:

  • The permanence of communication between the hollow surrounding the testis and the peritoneum (permanence of the sheath): A hydrocele in newborns is often continuous, as the open duct allows passage of peritoneal fluid into the cyst.
  • Increased fluid production in the scrotum or lack of fluid absorption from it. The most common cause of hydrocele in adults is filariasis (elephantomycosis), a parasitic infection, though this condition only appears in places where the disease is endemic.
  • Obstruction of lymphatic drainage of structures within the scrotum: A hydrocele may appear after varicocele surgery due to lymphatic drainage injury during the varicocele removal, which leads to fluid accumulation in the scrotum.

Also know how Varicocele treatment.

Symptoms of a hydrocele

The hydrocele around the testicle is often small and asymptomatic. However, the symptoms of a hydrocele appear only when it grows and becomes in the form of swelling or an apparent bulge on one or both sides of the scrotum, where the patient feels a sense of heaviness in the scrotum as a result of its filling with fluids. This swelling is often painless.

The swelling in the scrotum increases when the intra-abdominal pressure increases in connected hydroceles, but separate ones remain the same.

If the swelling is painful, we should suspect of inguinal hernia; Indirect (the descent of the intestine through the inguinal canal into the scrotum), as pain is often the difference between a hydrocele and an inguinal hernia, and they are distinguished by echocardiography.

Diagnosis of a hydrocele

A hydrocele is diagnosed clinically; there are clinical findings that require other diagnostic procedures. Among these directories:

  • The testicles are not well palpable.
  • Localized pain, fever, and gastrointestinal symptoms (e.g., vomiting).
  • Shadows inside the scortum during the scan.

The aiding tests for diagnosing a hydrocele around the testis are:

Translucency test

Translucency examination is to shine a light on the scrotum and see the shadow from the other side. If the shadow is transparent, this indicates the presence of a hydrocele. If there is a shadow inside the scrotum, it may be due to testicular swelling. This is the difference between a hydrocele and testicular cancer. As the hydrocele does not occur in the testicle but rather outside it, there is no swelling in the testicle; rather, it remains at its standard size.

Image showing translucency examination of a hydrocele
We notice the translucency of the light when shining a hydrocele in the scrotum

Laboratory tests

Hydrocele may occur around the testicle due to inflammation in the testicle or epididymis. To differentiate this condition from spontaneous hydrocele, some laboratory tests are performed to determine if the cause of this hydrocele is inflammatory or of another type.

In most cases, Laboratory tests also help differentiate a hydrocele around the testicle from testicular cancer and orchitis.

Ultrasound imaging

Ultrasound (echo) differentiates between hydroceles, spermatoceles, and testicular tumors.

It may be necessary to perform an ultrasound when the testicle is not palpated in the clinical examination, as the ultrasound may show testicular atrophy that may be caused by chronic torsion of the spermatic cord that led to testicular infarction.

Finally, the pain requires echo Doppler imaging of the testicular arteries, as the pain may be evidence of an infarct in the testicle.

Ultrasound image of fluid around the testicle
We notice the presence of fluid around the testicle at the ultrasound image

Abdominal x-ray

A simple abdominal x-ray image differentiates a hydrocele from an inguinal hernia. The image of the abdomen may show the presence of gases in the scrotum, indicating herniation of the intestine into the scrotum, which requires emergency intervention. Also, the intestines can be felt in the scrotum, indicating an inguinal hernia.

Hydrocele complications

Hydroceles are usually not dangerous and do not cause any problems with childbearing or sexual ability. Still, they may predispose to the occurrence of some difficulties in the future, such as:

  • Infection: It may affect the testicles and cause the inability to form sperm, thus affecting reproduction.
  • A connected hydrocele may predispose a segment of the intestine to enter and making inguinal hernia.

Treatment of a hydrocele around the testicle

Non-continuous hydrocele in adults does not need treatment unless symptoms appear, but relatively constant monitoring. When symptoms of a hydrocele appear, its treatment is surgical if we cannot treat the cause.

Hydrocele in infants does not usually need treatment because it is of the connected type and disappears automatically at one or two years old. The treatment of a hydrocele in adults is generally surgical.

Hydrocele cannot be treated with herbs.

Hydrocele operation in Türkiye

There are three ways to treat hydroceles surgically in Türkiye:

inguinal method

The process of removing water from the testicle by the inguinal method seems to be preferred in children who have a connected hydrocele, as it is entered from above the scrotum and the sheath process that connects the abdomen and the scrotum and leads to leakage of the peritoneal fluid into the scrotum.

It is preferable to perform this method when there is suspicion of testicular cancer so that the spermatic cord is tied before making any intervention on the tumor so that the cancer does not spread to other parts of the body.

across the scrotum

This method is preferably performed with excision of the tunica albuginea or inversion and suturing of the tunica albuginea in chronic non-communicating hydroceles. This operation should be avoided when there is any suspicion of a tumor.

Sclerotherapy

Sclerotherapy should remain the last resort in patients not candidates for surgery.

The method is done by suctioning water from the scrotum and injecting a sclerosing substance such as tetracycline into it. Repeating this process again is common, and complications such as severe pain or blockage of the epididymal canals may occur.

The success rate of per testicular hydrocele surgery is very high, with a lower recurrence rate than 1% when using the inguinal method and also across the scrotum. However, the rate of recurrence when using the sclerotherapy method is higher.

Follow-up after the hydrocele operation

It is recommended to visit the doctor at least once after the surgical procedure to ensure a full recovery, and a review may be warranted more than once a month or every two weeks.

Tips after a hydrocele operation

  • The wound should be kept clean and dry for at least 24 hours, and then the wound should be cleaned with a small amount of water for a week.
  • Wear tight pants for at least a week
  • Avoid immersing the operation area in water, even in the bathtub, for a whole week
  • If you feel pain in the place of the operation, contact the attending physician.

Complications of the hydrocele process

Caution must be taken when dealing with tissues, especially by the inguinal method, so as not to lead to injury to one of the structures of the spermatic cord, as it may lead to another hydrocele or cause damage to the vas deferens and lead to infertility.

A simple hydrocele often occurs after the operation, but it usually goes away within a week.

Finally, the occurrence of a hydrocele does not cause concern. Still, seeing the doctor to detect a hydrocele and distinguish it from testicular tumors is preferable. Often, the appearance of symptoms of a hydrocele around the testicle requires treatment through a hydrocele in Turkey, which is a straightforward surgical procedure with beautiful results. The Bimaristan Center offers the best doctors and surgical procedures for treating hydroceles in Turkey.


Sources:

  1. Mayo Clinic
  2. Cleveland Clinic
  3. Medscape

Frequently Asked Questions

It is a collection of clear fluids, most of which are water, inside the scrotum and around the testicles, which leads to an enlargement of the size of the scrotum and a feeling of heaviness. There are two types, as explained in this article.

The hydrocele operation is very simple and the results are good.

Waiting up to two years is often preferable in infants because it usually goes away independently.

In adults, if the hydrocele is due to a secondary cause, such as elephantiasis, treatment of the underlying disease may lead to the remission of the hydrocele.

Varicose veins are enlarged testicular veins and are often painful. As for the hydrocele, it collects fluid in the testicular covering.

There is a relationship between the process of varicose veins that lead to the occurrence of hydrocele, due to injury to the lymphatic vessels draining testicular fluids.

The large size of the hydrocele may put pressure on the arteries feeding the testicle, which leads to the death of the testicle due to the interruption of blood supply and, thus, the inability to produce sperm.

Depending on the method used, almost all methods do not take much time, and the patient can return home on the same day.

Women can have a hydrocele, a fluid collection in the nostril duct above the vagina.

If you are planning for treatment in Turkey
you can talk to us here.

If you are planning for treatment in Turkey
you can talk to us here.

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